Each year, the Health Information and Management Systems Society (HIMSS) puts on its annual conference, which draws large crowds from across the Health IT space – vendors, policy makers, press, consultants and multiple others. This year’s conference in Orlando drew about 33,000 attendees, and hosted an exhibit hall with over 500 different booths (with all the circus one can imagine).
Were there any salient themes from this year’s “state of the industry” get-together? Last year, perhaps the one outstanding theme was that cloud computing was the next “big thing” which would shift the tradition of health IT as a closed, enterprise installation into something more accessible and flexible.
The main themes from this year’s conference was summarized nicely as “advancing connectivity.” Since last year, Stage 1 Meaningful Use has been implemented, and vendors have been busily building products that (potentially) help physicians implement Electronic Health Records (EHR) systems into their daily workflows. If the theme of Stage 1 is “getting physicians used to interacting with computers for clinical documentation and workflow processes, and off of paper,” then the theme of Stage 2 is “connecting the dots together.” Connectivity is central to moving Health IT forward, and achieving the vision expounded by the Office of the National Coordinator (ONC) for Health IT.
What advances and challenges have emerged, as the industry tries to connect EHRs together – large, small, enterprise-installed and web-hosted? Much of the ONC effort has been focused on creating Health Information Exchanges (HIEs), which are businesses that can serve as hubs for data exchanges, much like how clearinghouses function for billing: billing software is capable of connecting with these clearinghouses, so that everyone using such billing software can submit claims from all the individual practices (or any source of medical billing creation), the hub verifies that the submitted data is formatted properly, and then batch-sends the data to the various insurance plans for payment. The central hub allows a single connection for a given medical practice, which can route bills to all the insurance plans with which the practice participates.
There have been many approaches as to how HIEs can function as businesses that will remain viable after initial federal seed money (from ONC grants) runs out. Some approaches are government/state sponsored, some are private companies, some are hosted by health plans for their enrollees.
Regardless of how these HIEs function, they will need to use technology that does the connecting – and many such technologies were represented at HIMSS. In fact, these technologies are in a rapid state of maturation, and may serve as ways to connect data sources in ways not currently envisioned – either via formal HIE organizations, or simply directly. As we have commented, the impact of web-based EHR uptake among small and middle-sized practices is that these practices’ EHRs are already connected to each other via the Internet. Connecting these EHRs to other places where health data resides (labs, hospitals, other large enterprise installations) becomes simpler, since a single connection at the web-vendor will immediately connect everyone using that system – there are fewer “dots” to connect.
There are significant challenges in this arena still needing to be overcome. As noted by others, there is increasing awareness that the CDA/CCD (HL7) standards are not at the level of plug-and-play compatibility. Because of “wiggle room” in the standards, customizations still are needed for each and every integration – that has certainly been our experience when connecting to laboratories. A truly “standard” standard for health data exchange still needs to emerge, and will be one of the front-and-center issues over the next year.
Another issue that needs work is the issue of “provider directories.” In order to data to be shared between two different systems, one needs to establish a trusted connection between known endpoints. Sometimes the place where you need to connect is an “entity” – a whole clinic, or a whole hospital (doesn’t matter who specifically within that entity). Such a provider directory is referred to as Entity-Level Provider Directories (ELPD). Such an “entity” generally has many individual members, and an individual can participate in several entities (I may be a member of my own clinic, perhaps also a community volunteer clinic, and also a local hospital). Other times one needs to connect to a very specific individual, regardless of where they may participate – such Individual-Level Provider Directories (ILPD) also need to exist, in addition to ELPDs.
The question then arises – who manages these Provider Directories? An HIE? A connectivity technology vendor? Is there to be a universal provider directory, or will each HIE build their own? What if the directories don’t match up? These are all questions that will need study and answers, and will be another front-and-center issue over the next year.
One lesson from HIMSS is certain: the Health IT field is large, varied and energized. Tremendous maturation is being witnessed in many areas of this ecosystem. Job growth opportunities are quite positive in this sector. And the need to “connect it all together” will be the challenge for established companies and start-ups alike. This is an unprecedented time.
Robert Rowley, MD
Chief Medical Officer
Practice Fusion EMR